Hypertension (edited) Flashcards
(177 cards)
1
Q
What’s the most common SE caused by diuretics?
A
Increase urination
2
Q
What’s the most common SE caused by ACE-I?
A
Cough
3
Q
What’s the most common SE caused by CCB, esp if high doses are used?
A
Peripheral Edema
4
Q
What’s classified as normal BP
A
< 120/80 mmHg
5
Q
What’s pre-HTN or elevated BP?
A
120-129/<80
6
Q
What’s stage 1 HTN according to classification of BP in adults according to JNC 7?
A
130-139/ OR 80-89
7
Q
What’s stage 2 HTN according to classification of BP in adults according to JNC 7?
A
> = 140/ OR 90
8
Q
What’s the compelling tx for HTN pt with HF?
A
ACE-I, ARB, BB, Diuretic, Aldosterone antagonist
9
Q
What’s the compelling tx for HTN pt with S/P MI?
A
ACE-I, BB, Aldosterone antagonist
10
Q
What’s the compelling tx for HTN pt with High risk of CAD?
A
ACE-I, BB, Diuretic, CCB
11
Q
What’s the compelling tx for HTN pt with DM?
A
ACE-I, ARB, BB, Diuretic, CCB
12
Q
What’s the compelling tx for HTN pt with CKD?
A
ACE-I, ARB
13
Q
What’s the compelling tx for HTN pt with recurrent stroke prevention?
A
ACE-I, Diuretic
14
Q
Drugs that can cause/ worsen HTN?
A
ADHD
Amphetamines
Decongestants (Pseudoephedrine, phenylephrine),
Erythropoietin Stimulating Agents (Epogen)
Immunosuppressants (Cyclosporine)
NSAIDs
systemic steroids
Alcohol (excessive), Appetite suppressants Caffeine, Estrogen, Herbals (bitter orange, ephedra (ma-huang), ginseng, Guarana, SJW), Mirabegron (Myrbetriq) Oncology drugs (Bevacizumab (Avastin), Sorafenib (Nexavar)), SNRIs (Duloxetine and Venlafaxine - at higher doses), Thyroid hormone (if given too much)
15
Q
According to ACC/AHA whats the BP goal in general population?
A
< 130/80mmHg for everyone
16
Q
According to ADA what’s BP goal for most diabetic pts?
A
< 140/90mmHg
17
Q
What’s the recommended initiation drug for non-black pts?
A
Thiazides or ACE-I or ARB or CCB
Alone or in combo
18
Q
What’s the recommended initiation drug for black pts?
A
Thiazides or CCB
Alone or in combo
19
Q
What’s the recommended initiation for all ages, all RACES, with CKD present?
A
ACE-I or ARB
(to decrease progression to ESRD)
CKD= eGFR<60 and/or albuminuria (ur alb >=300 or alb:creat >=300)
also for any race diabetic w/albuminuria
Alone or in combo with other drug class
20
Q
What’s defined as high risk in HTN pts?
A
DM w/albuminuria (give ACEi or ARB to all races)
CKD (give ACEi or ARB to all races)
Pt with baseline BP> 150/90 start 2 first line drugs
21
Q
Lifestyle modifications wrt WEIGHT that should be encouraged in HTN?
A
Maintain normal BMI and waist circumference
1 kg weight loss can decrease BP 1 mmHg
22
Q
Lifestyle modifications wrt EATING that should be encouraged in HTN?
A
Recommend DASH (dietary approaches to stop HTN) eating plan
Which is high in fruits and vegetables and recommended low-fat dairy products with reduced saturated and total fat
23
Q
Lifestyle modifications wrt SODIUM INTAKE that should be encouraged in HTN?
A
Limit Na to < 1.5g (1500mg)
24
Q
Lifestyle modifications wrt PHYSICAL ACTIVITY that should be encouraged in HTN?
A
Routine physical activity
Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week)
25
Lifestyle modifications wrt ALCOHOL consumption that should be encouraged in HTN?
Women - 1 drink/day
Men - 2 drinks/day
26
Lifestyle modifications wrt SMOKING that should be encouraged in HTN?
Smoking cessation
27
What should be controlled in HTN pts to reduce cardiovascular dx risk?
Control BG and Lipids (cholesterol)
28
When's Furosemide (loop diuretic) mostly used?
Heart failure
29
What may happen if Furosemide (loop) is used long-term? Supplement to use while on furosemide?
They can lower bone density
K supplements
30
Where do thiazides work on nephron?
Distal convoluted tubule of nephron (inhibit Na reabsorption)
= Na, Cl, H20, and K excretion
31
Where do loops work on nephron?
Ascending loop by blocking Na reabsorption
32
List agents under Thiazdes?
Chlorothiazide (Diuril)
Chlorthalidone ONLY one IV
Hydrochlorothiaze (Microzide)
Indapamide
Metolazone (Zaroxolyn)
33
What's the brand name of Hydrochlorothiazide (Thiazide diuretic)?
Capsule - Microzide
34
What's the point at which not much clinical benefit is seen in both Chlorthalidone and Hydrochlorothiaze (Microzide)?
> 25-50mg/ day
Though, max is 100mg/d
35
SEs of Thiazides?
Hypokalemia (can be avoided by regular intake of K rich foods)
Hyponatremia, Hypomagnesemia
Hyperuricemia (increase UA)
Elevated lipids (increase CH and TG)
Hyperglycemia
Hypercalcemia
Dizziness
Photosensitivity
Rash
36
Which Thiazide is effective in pts with reduced renal fxn?
Metolazone may work in decreased renal function or diuretic resistance
Other thiazides are NOT EFFECTIVE at CrCl<30
37
List loop diuretics agents (used mainly in HF)
Furosemide (LASIX) IV:PO 1:2
Bumetanide (Bumex) PO, IV
Torsemide (Demadex) PO, IV
Ethacrynic acid (Edecrin) PO, IV
38
What's the brand name of Furosemide PO, IV (loop diuretics)?
Lasix
39
What's the oral loop dose equivalency of Furosemide (Lasix)?
40mg
bumetanide 1
torsemide 20
furosemide 40
ethacrynic acid 50
40
What's the oral loop dose equivalency of Bumetanide?
1mg
bumetanide 1
torsemide 20
furosemide 40
ethacrynic acid 50
41
What's the oral loop dose equivalency of Torsemide (Demadex)?
20mg
bumetanide 1
torsemide 20
furosemide 40
ethacrynic acid 50
42
What's the oral loop dose equivalency of Ethacrynic (Edecrin)?
50mg
bumetanide 1
torsemide 20
furosemide 40
ethacrynic acid 50
43
What's the warning associated with loop diuretics?
Sulfa allergy
Doesn't apply to Ethacrynic acid (Edecrin)
44
Which loop diuretics does the sulfa allergy not apply to?
Ethacrynic acid (Edecrin)
45
SEs of loop diuretics?
Orthostatic hypotension
Hypokalemia, reduced Na, Mg, Cl, Ca
Metabolic acidosis (inc. HCO3)
Hyperuricemia
Elevated lipids (increase TC and TG)
Hyperglycemia (inc BG)
Photosensitivity
Ototoxicity, including hearing loss, tinnitus and vertigo
(ototoxicity risk highest with ethacrynic acid)
46
What's the difference btw effect of Thiazide and loop on Ca?
Thiazide => hypercalcemia
Loop=> hypocalcemia
47
Which loop causes the most Ototoxicity?
Ethacrynic acid (Edecrin)
48
List potassium-sparing diuretics
(K sparing = Aldosterone Receptor Antagonist-work on distal convoluted tubule and collecting duct)
Amiloride
Triamterene (Dyrenium)
Spironolactone (Aldactone, CaroSpir suspension)
Eplerenone (Inspra)
49
What's the brand name of Triamterene + HCTZ?
Maxzide
Maxzide-25
Dyazide
50
What's the brand name of Eplerenone?
Inspra
51
CI to potassium-sparing diuretics?
Renal impairment (CrCl < 30ml/min)
Hyperkalemia
Eplerenone concomitant use of strong 3A4 inhibitors
52
SEs to potassium-sparing diuretics?
Hyperkalemia (Do not start if K> 5.5)
Increased serum creatinine
53
SEs unique to Spironolactone (Aldactone)?
Gynecomastia
Breast tenderness
Impotence
54
Monitoring of potassium-sparing diuretics?
Check K before starting and frequently thereafter (NO start if K> 5.5)
BP
SCr/BUN
55
In what class of people is angioedema for the use RAAS inhibitors most common?
Black pts
56
T/F? If a person has had angioedema with any 1 of these agents, ACE-I, ARB or Aliskiren, then all others are CI?
T
Bcuz angioedema can get fatal very quickly
Counsel to report any swelling of lips, mouth, tongue, face or neck immediately
57
Are RAAS inh (ACE-I, ARB or Aliskiren) CI in pregnancy?
Yes
D/c drugs as soon as pregnancy is detected
58
List ACE-I agents
Benazepril (Lotensin)
Captopril (Capoten)
Enalapril, Enalaprilat IV injection (Vasotec)
Fosinopril
Lisinopril (Prinivil, Zestrin)
Moexipril
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik$
59
What's the brand name of Benazepril (ACE-I)?
Lotensin
60
What's the brand name of Enalapril, Enalaprilat IV injection (ACE-I)?
Vasotec
61
What's the brand name of Lisinopril (ACE-I)?
Prinivil
Zestril
62
What's the brand name of Quinapril (ACE-I)?
Accupril
63
What's the brand name of Ramipril (ACE-I)?
Altace
64
How's Captopril (Capoten) taken?
1 hr before meals
65
How's Moexipril (Univasc) taken?
On an empty stomach
66
Black box warning of ACE-I/ ARB/ Aliskiren (direct renin inh)?
D/c as soon as pregnancy is detected
67
CI of ACE-I/ ARB?
Angioedema Hx
Use within 36 hrs of sacubitril/valsartan
Bilateral renal artery stenosis
NO concurrently with Aliskiren in pts WITH DM
68
In what grp of pts can't ACE-I/ARB be used concurrently with Aliskiren?
Pts with DM
69
SEs of ACE-I/ ARB/ Aliskiren (direct renin inh)?
Cough
Hyperkalemia
Angioedema (d/c drug if it occurs)
Hypotension
70
Which SEs are specific to Captopril (Capoten) use - ACE-I?
Taste perversion
Rash
71
Monitoring of ACE-I/ ARB/ Aliskiren (direct renin inh)?
BP
K
Renal fxn
72
Pregnancy cat of ACE-I/ ARB/ Aliskiren (direct renin inh)?
D
73
List ARB agents
Valsartan (Diovan)
Losartan (Cozaar)
Irbesartan (Avapro)
Candesartan (Atacand)
Olmersartan (Benicar)
Telmisartan (Micardis)
Eprosartan (Teveten)
Azilsartan (Edarbi)
74
What's the brand name of Valsartan? ARB
Diovan
75
What's the brand name of Losartan? ARB
Cozaar
76
What's the brand name of Olmesartan? ARB
Benicar
77
MOA of direct renin inhibitor?
Directly inhibits renin, which is responsible for conversion of angiotensin to angiotensin I, a potent vasoconstrictor, thereby reducing BP
78
List agent under direct renin inhibitor
Aliskiren (Tektuma)
79
CI to Aliskiren (direct renin inh) use?
Don't use concurrently with ACE-I or ARBS in pts with diabetes
Angioedema
Bilateral renal artery stenosis
80
Effect of all RAAS inh on K?
All increase risk of HYPERkalemia
81
Which BB indicated for HTN only?
Nebivolol
82
BB with intrinsic sympathomimetic activity (ISA)?
-partially stimulate B receptors while blocking catecholamines (NE) = don't decrease HR to same degree as non-ISA BB
NOT recommended in post-MI pts
Acebutolol
Penbutolol
Pindolol
83
Place in therapy for BB with intrinsic sympathomimetic activity (ISA) - APP?
Pts with excessive bradycardia who need BB therapy
Don't reduce HR as much as other beta-blockers
NOT recommended in post-MI pts
84
List Beta-1 selective agents
AMEBBA
Atenolol (Tenormin)
Metoprolol tartrate (Lopressor) & succinate (Toprol XL)
Esmolol (Brevibloc)
Bisoprolol
Betaxolol
Acebutolol
85
Which BB has more CNS SEs? Why?
Propranolol
Has high lipid solubility (lipophilic) and crosses BBB=more CNS side effects BUT useful for other conditions (migraine prophylaxis, essential tremor)
86
Which BB should be with food?
Carvedilol ALL FORMS
87
Is Carvedilol CR same as Carvedilol IR?
CR is less bioavailable than IR NOT 1:1
88
What's the 1st line tx for HTN in pregnancy?
Labetalol
Nifedipine ER (Adalat, Procardia XL, Afeditab CR)
Methyldopa
89
Whys Propranolol used in stage fright?
Can cover up sx of shakiness, palpitations and anxiety (with hyperglycemia)
Occurs mostly in non-selective bb
90
List bb selective agents?
AMEBBA
Acebutolol (Sectral)
Atenolol (Tenormin)
Betaxolol
Bisoprolol (Zebeta)
Metoprolol tartate (Lopressor)
Metoprolol Succinate ext-release (Toprol XL)
91
What's the brand name of Atenolol? (Beta1-selective blockers)?
Tenormin
92
What's the brand name of Metoprolol tartrate? (Beta1-selective blockers)?
Lopressor
93
What's the brand name of Metoprolol succinate ext-release? (Beta1-selective blockers)?
Toprol XL
94
Most common SE of Beta1-selective blockers?
Reduced HR
Hypotension
Fatigue
Dizziness
95
Monitoring of Beta1-selective blockers?
HR
BP
96
How should bb be stopped?
Must taper
97
Which metoprolol is taken with food?
Metoprolol tartrate (Lopressor)
98
Are IV doses of Beta1-selective blockers equivalent to PO doses?
No
99
Which bb is both B-1 selective blocker and Nitric Oxide-Dependent vasodilation?
Nebivolol (Bystolic)
100
What's the brand name of Nebivolol? (B-1 selective blocker and Nitric Oxide-Dependent vasodilation)
Bystolic
| NO causes peripheral vasodilation
101
SEs of Nebivolol (Bystolic)? (B-1 selective blocker and Nitric Oxide-Dependent vasodilation)
Nausea
Diarrhea
Increase TG
Decrease HDL
102
List non-selective bb (B1 & B2)
Nadolol (Corgard)
Pindolol
Propranolol (Inderal LA, InnoPran XL)
Timolol
103
What's the brand name of Propranolol? (Non-selective bb)
Inderal LA
InnoPran XL
104
List bb that are non-selective beta-blocker and alpha 1 blocker
Carvedilol (Coreg, Coreg CR)
Labetalol
105
Brand name of Carvedilol (non-selective alpha- and beta-blocker)?
Coreg
Coreg CR
106
How should all forms of Carvedilol be taken?
With food
107
Types of CCBs?
Dihydropyridines
Non-dihydropyridines
108
Where does dihydropyridine work?
Periphery
109
List dihydropyridine CCBs
```
Amlodipine (Norvasc)
Felodipine
Isradipine
Nisoldipine ER
Nicardipine IR TID, ER BID, IV (Cardene)
clevidipine (Cleviprex)
nifedipine (Adalat, Procardia)
```
110
Brand name of Amlodipine (dihydropyridine CCBs)?
Norvasc
111
Brand name of Nifedipine ER (dihydropyridine CCBs)?
Adalat CC
Procardia XL
Afeditab CR
112
Brand name of Nicardipine IV (dihydropyridine CCBs)?
Cardene
113
SEs of Dihydropyridine CCBs?
Peripheral edema
Headache
Flushing
Tachycardia/reflex
Gingival hyperplasia
114
Monitoring of Dihydropyridine CCBs?
Peripheral edema
115
Which Dihydropyridine CCBs is used in inpatient acute care?
Clevidipine (Cleviprex)
116
Non-Dihydropyridine CCBs?
Inhibit Ca2+ ions smooth muscle and myocardium, but more selective for myocardium than DHP CCB.
decrease BP by negative inotropic effect (less ventricular contraction force)
and decrease HR by negative chronotopic effect
117
List Non-Dihydropyridine CCBs agents
Diltiazem (Cardizem, Tiazac)
Verapamil (Calan, Verelan)
118
SEs of Non-Dihydropyridine CCBs?
Edema
Headache
Bradycardia
Hypotension
Arrhythmias
worsen HF symptoms
Constipation (more verapamil)
Gingival hyperplasia
119
Uses of Clonidine?
Most commonly used for resistant HTN and in pts who can't swallow
120
List agents under Centrally-Acting Alpha2 Agonist
Clonidine (Catapres; Catapres-TTS patch) Kapvay-ADHD
Guanfacine IR(Tenex)....ER (Intuniv-used for ADHD)
Methyldopa
121
Brand name of Clonidine (Centrally-Acting Alpha2 Agonist)?
Catapres
Catapres-TTS patch
Kapvay-ADHD
122
SEs of Centrally-Acting Alpha2 Agonist?
Dry mouth, somnolence, fatigue, dizziness, constipation, decrease HR (brady), hypotension
headache
Depression
Psychotic rxns-behavioral changes
Nasal stuffiness
Sexual dysfxn
123
How often is Clonidine patch (Catapress-TTS) applied?
Weekly-on hairless area of upper outer arm or chest
124
List direct vasodilators agents
(vasodilator arterioles with little effect on veins= decrease SVR therefore decrease BP)
Hydralazine
Minoxidil
125
SEs of direct vasodilators (Hydralazine and Minoxidil)?
Warning: DILE (dose &duration related)
Headache
Reflex tachycardia
Palpitations
minoxidil box (potent antihypertensive)
126
List alpha blockers agents
Not recommended for HTN but may be used in men with HTN and BPH
block a1 receptors on arterioles & veins= peripheral vasodilation
Prazosin (Minipress)
Terazosin (Hytrin)
Doxazosin (Cardura, Cardura XL)
127
What's the brand name of Terazosin (Alpha blockers)?
Hytrin
128
What's the brand name of Doxazosin (Alpha blockers)?
Cardura
Cardura XL
129
What's the brand name of Amlodipine + Benazepril? Classes?
Lotrel
ACE-I and CCB
130
What's the brand name of Lisinopril + HCTZ? Classes?
Prinzide
Zestoretic
ACE-I and Diuretic
131
What's the brand name of Losartan + HCTZ? Classes?
Hyzaar
ARB and diuretic
132
What's the brand name of Valsartan + HCTZ? Classes?
Diovan HCT
ARB and diuretic
133
What's the brand name of Olmesartan + HCTZ? Classes?
Benicar
ARB and diuretic
134
What's the brand name of Bisoprolol + HCTZ? Classes?
Ziac
BB and diuretic
135
What's the brand name of Triamterene + HCTZ? Classes?
Dyazide, Maxzide
Diuretic and diuretic
136
What's HTN urgency?
BP (gen >= 180/120) w/o acute target organ damage
137
Tx of HTN urgency?
Oral med with onset of action of 15-30 mins
Reduce BP gradually over 24-48 hr
138
What's HTN emergency?
BP (gen >= 180/110-120) + acute target organ damage (such as encephalopathy, MI, unstable angina, pulmonary edema, eclampsia, stroke, aortic dissection)
139
Tx of HTN emergency?
Reduce MAP by no more than 25% (within 1 hr)
If stable, to 160/100mmHg within the next 2-6 hrs
Use IV meds
140
List drugs used in HTN urgencies
short onset of action
Captopril (Capoten)
Clonidine (Catapres)
Labetalol (Trandate)
141
What's the dose of Captopril (Capoten) and SEs used in HTN urgencies?
Captopril (Capoten) 25mg, repeat in 1-2 hrs PRN
Hypotension, high K, angioedema
142
What's the dose of Clonidine (Catapres) and SEs used in HTN urgencies?
Clonidine (Catapres) 0.1-0.2mg, repeat in 1-2 hrs PRN
Hypotension, drowsiness, sedation, dry mouth etc
143
What's the dose of Labetalol (Trandate) and SEs used in HTN urgencies?
Labetalol (Trandate) 100-400mg, repeat in 2-3 hrs PRN
Hypotension, heart block, bronchoconstriction
144
Drugs used in HTN emergencies?
```
chlorothiazide
Clevidipine (Cleviprex) - DHP-CCB
diltiazem
Sodium Nitroprusside (Nitropress) - Arteriole &Venous VD
hydralazine
Nicardipine (Cardene) - DHP-CCB
metoprolol tartrate
NTG - venous vasodilator
propanolol
Enalaprilat (Vasotec IV) - ACE-I
verapamil
Hydralazine - Arteriole vasodilator
```
Labetalol (Trandate) - Alpha&beta blocker
Esmolol (Brevibloc) - bb
145
What's in the drug Exforge?
Amlodipine + Valsartan
146
What BP med is C/I with Sodium Polystyrene Sulfonate (Kayexalate)? Why?
ACE-I, ARBs and DRI
These meds increase potassium (cause hyperkalemia)... SPS (Kayexalate) is used to treat hyperkalemia
147
MOA of Clonidine?
Alpha-2 AGONIST => reduces norepinephrine release=decrease SNS stimulation=decrease SVR and decrease HR
also the MOA for methyldopa and Guanfacine
148
List BP meds not used with grapefruit/ grapefruit juice?
```
all CCB
Cardizem LA (Diltazem)
```
Calan SR (Verapamil)
Dilt-XR (Diltazem hydrochloride extended release)
149
SE of Clonidine?
Can worsen Constipation, Depression, Fatigue
150
Effect of Diltazem and Verapamil on hepatic metabolism of other drugs?
CYP 3A4 inhibitor
151
How should BP be lowered in HTN emergency?
10-15% in next hr
152
What's the unique SE of Olmesartan?
Sprue-like enteropathy
153
Which SE is unique to Verapamil?
Constipation
154
Is cough a common SE of ARBs?
No!
Cough is ACE-I
155
What makes up Lotrel?
Amlodipine and Benazepril
156
What makes up Exforge?
Amlodipine and Valsartan
157
What makes up Lotensin HCT?
Benazepril and HCTZ
158
What makes up Prinzide (also called Zestoretic)?
Lisinopril and HCTZ
159
What makes up Hyzaar?
Losartan and HCTZ
160
What makes up Micardis HCT?
Telmisartan and HCTZ
161
What makes up Diovan HCT?
Valsartan and HCTZ
162
What makes up Benicar HCT?
Olmesartan and HCTZ
163
What makes up Ziac?
Bisoprolol and HCTZ
164
What makes up Dyazide (also called Maxzide)?
Triamterene and HCTZ
165
What's the conversion of Carvedilol IR to Carvedilol CR?
3.125mg BID (Coreg) = 10mg daily (Coreg CR)
166
Which BP med is considered safe in pregnancy?
HCTZ
167
What BP med is the drug of choice for HTN patient with aortic dissection?
Beta-blocker
168
What's the most common SE caused by BB?
Fatigue (and sometimes sexual problems)
169
Clevedipine kcal
clevedipine (Cleviprex) is a DHP CCB lipid emulsion with milky white color provides 2 kcal/mL
Must be used within 12 hours of vial puncture
170
Thiazides and lithium
thiazides decrease lithium clearance
| =increase lithium toxicity risk
171
BB are first line for which conditions
post-MI
stable ischemic heart disease
HF- bisprolol, carvedilol, metoprolol succinate
172
BB warnings (ALL)
Box: Don't abruptly D/C Must Taper
Caution w/ diabetes: Can MASK hyper/hypo glycemia
Caution is asthma/COPD
BB can decrease insulin secretion which can cause hyperglycemia
173
non-selective BB w/a-1 activity warning
floppy iris
174
metoprolol tartrate IV:PO
(Lopressor)
IV:PO
1: 2.5
175
both metoprolols should be taken
with or immediately following food
176
unique to methyldopa
CI: use w/MAOi
hemolytic anemia risk, DILE
drug of choice for HTN in pregnancy
177
natural products
```
fish oil
coQ10
garlic
L-arginine
have some evidence for decreasing BP and overall cardiovascular risk though not guideline recommended
```
